Colectomia em paciente com câncer de cólon: relato de caso

Objetivo: Relatar o caso de um paciente com câncer de cólon, descoberto em um hospital de referência em cirurgia de uma cidade do Estado do Pará. Relato de caso: Masculino, 64 anos, queixa-se de diarreia, astenia e emagrecimento. Ao exame físico, apresentou massa palpável de 15cm e móvel em flanco direito. A tomografia computadorizada de abdome total com contraste evidenciou tumor de cólon ascendente. Colonoscopia apresentou tumoração blastomatosa infiltrativa com estenose luminal em cólon ascendente distal; pólipo séssil no cólon transverso; biopsia apontou adenocarcinoma moderadamente diferenciado. Após análise dos dados, confirmou-se o diagnóstico de câncer de cólon. O paciente foi submetido à hemicolectomia direita ampliada, peritonectomia localizada, linfadenectomia e reconstrução com anastomose íleo-transversa término-lateral em dois planos. A biópsia da peça cirúrgica reveloucólon ascendente com adenocarcinoma tubular moderadamente diferenciado medindo 5,0 cm e infiltrando até o mesocólon. O estadiamento do câncer indicou T3N2M0 e Dukes C. Orientou-se seguimento oncológico semestral. Considerações finais: É fundamental a investigação eabordagem cirúrgica imediata frente às suspeitas neoplásicas dessa natureza, visando reduzir metástases, dado à lentidão dos métodos diagnósticos de um serviço de saúde pública do país.

The prognostic role of tissue TLR2 and TLR4 in colorectal cancer

Colorectal cancer (CRC), the second most common cancer globally, resulted in 881,000 deaths in 2018. Toll-like receptors (TLRs) are crucial to detecting pathogen invasion and inducing the host’s immune response. This study aimed to explore the prognostic value of TLR2 and TLR4 tumor expressions in colorectal cancer patients. We studied the immunohistochemical expressions of TLR2 and TLR4 using tissue microarray specimens from 825 patients undergoing surgery in the Department of Surgery, Helsinki University Hospital, between 1982 and 2002. We assessed the relationships between TLR2 and TLR4 expressions and clinicopathological variables and patient survival. We generated survival curves using the Kaplan-Meier method, determining significance with the log-rank test. Among patients with lymph node–positive disease and no distant metastases (Dukes C), a strong TLR2 immunoactivity associated with a better prognosis (p < 0.001). Among patients with local Dukes B disease, a strong TLR4 immunoactivity associated with a worse disease-specific survival (DSS; p = 0.017). In the multivariate survival analysis, moderate TLR4 immunoactivity compared with strong TLR4 immunoactivity (hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49–0.89, p = 0.007) served as an independent prognostic factor. In the multivariate analysis for the Dukes subgroups, moderate TLR2 immunoactivity (HR 2.63, 95% CI 1.56–4.44, p < 0.001) compared with strong TLR2 immunoactivity served as an independent negative prognostic factor in the Dukes C subgroup. TLR2 and TLR4 might be new prognostic factors to indicate which CRC patients require adjuvant therapy and which could spare from an unnecessary follow-up, but further investigations are needed.

Changes of Serum CEA Level after Resection of Colorectal Carcinoma

Introduction :Carcinoembryonic antigen is the most commonly used tumour associatedantigen in the management of patients with colorectal carcinoma. The test appearsuseful to determine prognosis and to monitor patients with colorectal carcinoma for earlyrecurrence, persistent elevation of CEA for a month after operation suggests thepresence of occult metastatic disease. Objective: The study was done to compare pre and postoperative CEA level in colorectalcarcinoma patient and to analyze the relationship of CEA and different Dukes stage inpre operative period of colorectal carcinoma patients. Methods: This cross-sectional and cohort study was performed to look at the change inCEA level among 97 colorectal carcinoma patients in pre and post operative state in thedepartment of surgical oncology, NICRH from January 2010 to June 2012. Results :Statistically significant changes was found in pre and postoperative CEA levelin colorectal carcinoma patient (p <.001). Preoperative CEA level was raised in Dukes8(40%) and Dukes C(54%). Conclusion :Postoperative CEA level was significantly reduced after resection of colorectalcarcinoma and neck neoplasm. Journal of Surgical Sciences (2016) Vol. 20 (1) : 3-6

Anatomical and Immunohistochemical Evaluation of Colorectal Cancer

Colorectal cancer is a malignant disease with high morbidity and mortality. Ki-67 is a marker of cell proliferation associated with a low survival in colorectal cancer patients. Its expression is increased in patients with Dukes C or D colorectal cancer versus those in stage A or B. The purpose of the study is to evaluate the immunohistochemical expression of the Ki-67 marker in colorectal adenocarcinomas. The study was performed on a group of 28 patients diagnosed with rectal cancer. We made the histopathological and immunohistochemical evaluation of patients in the study group. The evaluation was performed on the sections stained with hematoxylin-eosin, and for mucinous forms, on sections stained with alcian blue. The topography of the Ki-67 reaction is strictly nuclear, evident in areas with intense proliferative activity. In cases with a strong positive response to Ki-67, the prognosis is worse, with invasion of the perirectal tissues and metastases. The lack of Ki-67 expression in nearby neoplastic tissues suggests that cancerous tissue proliferates in a pathway that it is not correlated with adjacent tissues. The Ki-67 could be useful in the prognosis of patients with colorectal cancer.

Colorectal cancer

Colorectal cancer may present with anaemia, bleeding, bowel habit change, or as an emergency with obstruction/perforation. Diagnosis is most commonly on endoscopy and biopsy. CT staging is a universal assessment, and MRI is used for local staging of rectal cancer. Treatment is according to stage, but primary cancer is most often resected, and principles of resection in the colon and rectum are discussed. Neo-adjuvant radiotherapy is given in moderate or high risk rectal cancer. Adjuvant chemotherapy is recommended for Dukes C tumours and for selected Dukes B.

Management of Sigmoid Cancer In dr Cipto Mangunkusumo Hospital during 2008–2011

A retrospective analysis was performed to sigmoid cancer cases in the digestive surgery division of Cipto Mangunkusumo Hospital during the period of 2008–2011. Fifty–two cases were analyzed for metastases, stages and histopathology; mortality and morbidity were calculated for anastomotic leakage, 3–year survival, and incidence of local recurrence. Three–year survival analysis was performed using Kaplan–Meier based on staging and histopathology. The overall operative mortality was 1.9%, and the anastomotic leakage incidence was 8.1%. The incidence of local recurrence was 9.1%. The 3–year survival rates based on Dukes Staging were as follows: 100% survival for Dukes A, 95.5% for Dukes B and 61.1% for Dukes C and 0% for Dukes C. The 3–year survival rates in sigmoid cancer according to histopathology were 73.5% for well differentiated, 63.6% for moderately differentiated and 100% for poorly differentiated (sample size was one patient, could not be assessed), with 50% survival for mucinous histopathology. The overall survival in this sigmoid cancer study was 69.2%.

Asociación entre la Proteína p53 Mutada, Grado de Infiltración y Tamaño del Tumor en Cáncer Colorrectal. Hospital Central Fap 1987-1996

OBJETIVO: Determinar la presencia de proteína p53 mutada en pacientes con cáncer colorrectal, y correlacionarla con el tamaño del tumor y grado de infiltración (Dukes). MATERIALES Y MÉTODOS: Se estudió retrospectivamente 40 muestras de casos diagnosticados como carcinoma colorrectal de los registros del Hospital Central FAP, entre los años 1987-1996. Se empleó el método inmunohistoquímico estreptavidina-biotina peroxidasa con el anticuerpo do-7 y con pretratamiento con microondas para la demostración de proteína p53 mutada. RESULTADOS: Todos los casos fueron adenocarcinomas, en la gran mayoría medianamente diferenciados; 18 pertenecían a la clasificación Dukes B, 16 a Dukes C, 4 a Dukes A y 2 a Dukes D. El tamaño del tumor era directamente proporcional al grado de infiltración, con un promedio de 5,5 cm3 para Dukes A, y 50,12 cm3 para Dukes D. La presencia total de proteína p53 mutada fue 55%, la positividad fue creciendo según el grado de infiltración del tumor (a = 0,353) y del tamaño del tumor (a = 0,376). CONCLUSIÓN: Entre los casos estudiados, la acumulación de proteína p53 mutada estuvo en relación directa al tamaño y grado de infiltración del tumor.

THE RELATION BETWEEN THE CEA, CA19-9 LEVELS AND HISTOPATHOLOGICAL CHARACTERISTICS IN COLORECTAL CANCER

Aim: Studying the combination of CEA and CA 19-9 levels with histopathological characteristics as well as monitoring recurrence and metastasis in patients with colorectal cancer. Materials and method: 66 patients diagnosed and treated for colorectal cancer at Hue Central Hospital from April 2012 to July 2013. The level of CEA > 5 ng/ml was defined as abnormal (CEA (+)), while the cutoff for the CA 19-9 was set at 37 U/mL (CA 19-9 (+)). Results: The positive rates of serum CEA and CA19-9 before surgery was 46.9%, 16.7%. When combination of CEA and CA 19-9, this rate increased to 50 %. The proportion of cancer wale was 77.3 %, tumor size T3 was majority of 65.2%. Adenocarcinoma was the highest percentage of 94.0%, 6.0%. The well differentiated adenocarcinoma was 62.1%, Dukes B (53%). The elevation of serum CEA related to the Dukes stage (p<0.05). CA 19-9 is not. when two marker were used, the preoperative elevation of CEA and CA 19-9 was significantly correlated with the Dukes stages. (p<0.05). The percentage of patients with recurrence was 9.1%, metastases was 18.2%. Conclusions: The measurement of CEA and CA 19-9 had prognostic value in patients with colorectal cancer at the late stage (Dukes C and Dukes D). In addition, CEA and CA 19-9 were an efficient way to detect and monitor patients with recurrence or metastasis. Key words: Colorectal cancer, CEA, CA 19-9, recurrence, metastasis